背景:前臂远端骨折定义为桡骨远端骨折合并尺骨远端骨折,除了尺骨茎突骨折.前臂远端骨折在老年人群中很常见,特别是那些患有骨质疏松症的人。传统上,前臂远端骨折通过双切口入路减少;然而,桡尺远侧关节的错误复位和不稳定并不少见。我们引入了改良的掌侧双窗入路治疗前臂远端骨折,并评估功能结果和并发症。
方法:从2020年1月至2023年6月,对13例前臂远端骨折患者进行了改良双窗入路锁定钢板内固定的切开复位。手术后,夹板应用两周,术后手部治疗3个月。手臂的平均快速残疾,肩膀,和手得分,运动范围,握力,术后影像学参数,收集并发症数据。
结果:平均随访时间为12.1个月,平均年龄为52.3岁。平均腕关节屈曲67°,延伸69°,内旋81°,和仰卧起坐79°。握力28.3±11.5kg,这是未受伤的对面的88%。活动期间的视觉模拟量表评分记录为0.5±0.9。手臂的平均快速残疾,肩膀,手评分为14±11.5。术后影像学参数如下:径向高度:10.8±1.7mm,径向倾角:22.6±3.7°,掌侧倾斜:4.0±3.9°,尺骨方差:-0.4±1.4mm。所有患者在最后一次随访时都实现了骨愈合。由于刺激症状,两名患者接受了尺骨植入物移除。既没有感染,也没有神经血管损伤,这些患者也没有出现减少不良。
结论:改良掌侧双窗入路可获得良好的腕关节功能和前臂远端骨折复位,且不增加神经血管或伤口愈合并发症。这种方法是前臂远端骨折的替代方法,尤其是尺骨远端粉碎性骨折或尺尺远端关节不协调。
BACKGROUND: Distal forearm fractures were defined as distal radius fractures with concomitant distal ulna fractures, except ulna styloid fractures. Distal forearm fractures are common among geriatric populations, particularly those with osteoporosis. Conventionally, distal forearm fractures are reduced by a double incision approach; however, malreduction and instability of the distal radioulnar joint were not uncommon. We introduced a modified volar dual window approach to treat the distal forearm fracture and evaluate the functional outcomes and complications.
METHODS: From January 2020 to June 2023, 13 patients with distal forearm fractures underwent open reduction by the modified dual window approach with locking plate fixation. After surgery, splints were applied for two weeks, and the patients underwent postoperative hand therapy for three months. The mean Quick Disabilities of the Arm, Shoulder, and Hand scores, range of motions, grip strength, postoperative radiographic parameters, and complications data were collected.
RESULTS: The mean follow-up period was 12.1 months, and the mean age was 52.3 years. Average wrist flexion was 67°, extension 69°, pronation 81°, and supination 79°. Grip strength was 28.3 ± 11.5 kg, which was 88% of the uninjured opposite side. The Visual Analog Scale score during activities was recorded as 0.5 ± 0.9. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14 ± 11.5. The postoperative radiographic parameters were as follows: radial height: 10.8 ± 1.7 mm, radial inclination: 22.6 ± 3.7°, volar tilting: 4.0 ± 3.9°, and ulnar variance: -0.4 ± 1.4 mm. All the patients achieved bone union at the final follow-up. Two patients underwent ulnar implant removal due to irritation symptoms. Neither infection, nor neurovascular injury, nor malreduction developed in these patients.
CONCLUSIONS: The modified volar dual window approach can achieve good wrist function and distal forearm fracture reduction without increasing neurovascular or wound healing complications. This method is an alternative approach for distal forearm fracture, especially in comminuted distal ulna fracture or distal radioulnar joint incongruity.